Cardiovascular disease accounts for 43% of all deaths in patients with endstage renal disease, and CVD continues to remain the leading cause of mortality and morbidity following renal transplantation. However, the characteristics and the hospital mortality of acute myocardial infarction (AMI) in patients with kidney transplantation (KT) remain to be determined in large scale study. From the French nationwide hospital medical information database, all the consecutive patients hospitalized in the 1546 French hospital/clinics for AMI from 1st January 2005 to 31st December 2009 were included. We compared the specific profile and the hospital mortality of patients with KT to patients without renal failure. Patients with personal past history of renal failure and/ or dialysis were excluded.

Among the 329 839 patients with AMI included, 404 (0.1%) patients were after KT. Patients with KT were more frequently men (78.7 vs 66.8%, with p<0.001), markedly younger (58±12 vs 68±11, with p<0.001), and les smoker (5.0 vs 9.1%, with p<0.001) than patients without KT. There was also a higher proportion of hypertension (28.5 vs 23.4%, with p0.017) and a lower proportion of STEMI (75.7 vs 82.7%, with p<0.001) in patients after KT. More than two-thirds of AMI complicating post KT period occured before discharge (67.1%) and 91% in the first year after KT. After adjustment for age, sex and STEMI, in-hospital mortality was higher in KT group (4.2 vs 2.9%), but with p=0.210.

From our large scale nationwide study, our work demonstrated that patients with KT complicated by AMI are markedly younger with a specific difference for usual risk factors, but transplant-related risk factors explain also this specificity. We highligts that AMI occurs very early after KT, most often before discharge. To decrease the frequency of MI following renal transplantation, screening of coronaropathy and evaluation of risk factors before KT, as well as after KT must be evaluated.